Researchers conducted a prospective study and literature review to evaluate the utility of high-frequency ultrasound (HFUS), dermatoscopy, and confocal microscopy in assessing psoriasis plaques. “Psoriatic arthritis, metabolic syndrome, depression, non-alcoholic fatty liver disease, Crohn’s disease, lymphoma, and cardiovascular issues are among the chronic illnesses that people with psoriasis are more likely to develop. To prevent these complications, a correct diagnosis is necessary as early and as accurately as possible,” wrote Mircea Negrutiu and colleagues in Diagnostics.

The diagnosis of plaque psoriasis is mainly clinical, supported by histopathology in ambiguous cases.

“Currently, the imaging assessment of psoriasis vulgaris plaques is a field of research in continuous evolution, with an emphasis on the development and validation of non-invasive methods for assessing the severity of skin lesions, monitoring the progress of the disease, and the response to treatment,” the authors wrote.

The researchers recruited 15 patients with moderate-to-severe psoriasis and analyzed 60 plaques from the trunk and limbs. They performed HFUS using a 20 MHz probe to assess the thickness of the epidermis and dermis and evaluate local vascularization. Dermatoscopy and video-dermatoscopy provided detailed information on vascular patterns and scale distribution. The authors used confocal microscopy in vivo and ex vivo to examine structural and cellular changes in psoriatic lesions. HFUS showed increased epidermal and dermal thickness, a hypoechoic band in the upper dermis, and increased local vascularization, consistent with active disease. Dermatoscopy showed dotted vessels on an erythematous background with white scales. Video-dermatoscopy identified twisted loops and bushy vessels, with the latter being more common. Confocal microscopy correlated well with histology for revealing features such as psoriasiform hyperplasia, parakeratosis, and inflammatory infiltrates.

Imaging techniques offer significant advantages in diagnosing and managing psoriasis vulgaris. HFUS allows for non-invasive evaluation of skin structures and the monitoring of therapeutic responses. Dermatoscopy aids in the differential diagnosis and assessment of treatment efficacy. Confocal microscopy provides highresolution images, closely correlating with histological findings, and facilitates detailed examination of inflammatory processes. Despite these benefits, limitations include the need for experienced operators, the subjectivity of dermatoscopy, and the invasive nature of confocal microscopy. The researchers added that AI is gaining traction and could be used to extract meaningful features from images.

Negrutiu and colleagues concluded, “The assessment and monitoring of patients with psoriasis vulgaris can be conducted in a more complete and all-encompassing manner by incorporating dermatoscopy, ultrasonography, and confocal microscopy. By combining different imaging modalities, it may be possible to build individualized treatment plans and gain a better knowledge of the pathophysiology of psoriasis.”